Volume 9 (2024-25)

The healthcare industry is navigating unprecedented challenges, including workforce instability, rising costs and evolving patient expectations. To address these complexities, leaders must foster a culture of continuous improvement grounded in strategic innovation, operational efficiency and sound financial stewardship. This paper examines how healthcare organisations can harness technology, streamline workflows and leverage financial insights to tackle pressing issues. Notable initiatives at Penn Medicine, such as the OnDemand Virtual Care Platform and nurse triage technology, demonstrate the transformative potential of innovative strategies in improving patient outcomes, alleviating provider burnout and achieving operational excellence. By embracing a holistic leadership approach, healthcare organisations can overcome current challenges and build a resilient, patient-centred future. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: healthcare innovation; operational excellence; workforce burnout; financial stewardship; patient-centred care; health information technology; leadership

Healthcare organisations face increasingly complex challenges, including rising patient acuity, workforce shortages, cost pressures, reimbursement constraints and uncertain legislation. To address these pressing issues and drive operational and financial improvements, it is crucial to move beyond siloed thinking and embrace the power of dyadic leadership models. This paper aims to demonstrate the critical importance of clinical/operational dyadic partnerships in redesigning healthcare delivery and improving patient outcomes. By examining real-world examples focused on enhancing patient flow, efficiency, quality, safety and experience, the paper provides practical insights into building trust-based relationships, establishing effective governance models, clarifying roles and responsibilities, selecting accountable dyadic partners, creating and executing on shared goals, and developing essential leadership competencies. The paper will equip readers with methods for fostering successful dyadic leadership team building, enabling them to elevate healthcare delivery to new heights and enhance effectiveness as leaders. Specifically, this paper addresses the following: (1) cultivating trusting and collaborative relationships among interdisciplinary team members to leverage diverse perspectives in problem-solving and decision-making processes; (2) designing and implementing a comprehensive process for establishing effective dyadic partnerships and governance models in process design and improvement initiatives, ensuring inclusive stakeholder participation; (3) enhancing role clarity between dyadic partners, enabling them to work synergistically towards achieving optimal patient care outcomes; (4) developing strategies for assessing, selecting and holding dyadic partners accountable, facilitating a culture of shared responsibility and continuous improvement; and (5) identifying and fostering essential leadership competencies required in dyadic models, empowering healthcare professionals to drive transformative change within their organisations. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: leadership; dyads; transformation; structure

This study examines consumer sentiments regarding telehealth services and offers healthcare providers actionable recommendations for effective marketing techniques to engage existing and prospective patients. By effectively customising telehealth communication to align with distinct patient demographics, healthcare organisations can mitigate advertising inefficiencies and amplify the positive impact of telehealth services. Yet, despite its relevance, there exists a notable research gap concerning optimal marketing approaches for telehealth services. Utilising secondary survey data, researchers construct a telehealth user lookalike profile. This study will assist healthcare administrators and practitioners understand the demographic predisposition towards telehealth adoption. Additionally, it offers valuable insights into crafting targeted messaging and strategically identifying promotion platforms tailored to this receptive audience. This article is also included in The Business & Management Collection which can be accessed at https:// hstalks.com/business/
Keywords: telehealth; telemedicine; marketing strategy; patient engagement; patient attitudes; home care; technology adoption; target marketing; digital health

The ongoing transition by federal and commercial payers from fee-for-service to value-based reimbursement increases the need for sustainable and scalable high-performing ambulatory care management programmes to support patients across the continuum of care. In this paper we describe one health system’s approach to integrating distinct care management programmes into one aligned structure and standardising best practice workflows. We established and implemented organising principles for the restructuring, including standard documentation, reducing the burden on clinicians, transparently measuring both process and outcome measures and optimising the use of technology solutions. We internally validated and then applied risk stratification rubrics within the electronic health record to stratify our patient population and calibrate the intensity of our care management models based on patient clinical risk. Risk stratification, standardisation of work and introduction of automated outreach allowed the team to increase call volumes, maintain a 77 per cent connection rate to patients post discharge and create a new chronic care management programme without an increase in the number of full-time equivalent (FTE) roles. Important lessons learned include the importance of clearly communicating changes and performance to front-line clinicians and leadership; and garnering feedback from stakeholders to guide continuous optimisation of our standardised workflows. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: care management; integrated delivery healthcare system; advanced primary care; transitions of care; post hospital patient engagement

Healthcare organisations are people-intensive, complex systems. Traditionally, effective leadership required the leader to possess and develop skills and competencies; however, these alone are insufficient to generate aligned and sustained change. A standardised and systematic leadership approach, aligned with strategy, can help leaders move from reactive daily problem-solving to a culture of learning, improvement and innovation. Utilising the Baldrige Framework for Excellence, GBMC HealthCare developed and implemented a formalised Leadership System that is grounded in the organisation’s mission, vision and values. It considers stakeholder requirements and provides a stepwise standard approach for setting direction, building commitment, action planning, achieving results and developing people. Each step of the Leadership System has associated competencies that are used to foster development and growth. This approach was deployed across the GBMC HealthCare System, a community-based continuum of care organisation that includes an acute care hospital, a large hospice and elder care company and an ambulatory and specialty care provider group. Through case study, this paper details the framework and steps taken to develop and deploy a Leadership System that has led to sustained clinical and operational improvement. GBMC achieved the Baldrige Award in 2020, the nation’s highest presidential honour for performance excellence. In 2019, the Leadership System was recognised by Baldrige as a national best practice. Organisations can easily adopt this low-cost, high-impact method to create a standardised approach to help leaders achieve excellence both in their day-to-day activities and in guiding long-term strategic results. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: leadership system; Baldrige Framework for Excellence; change management; strategic integration; innovative leadership; mission-focused leadership

Workforce shortages, exacerbated by the COVID-19 pandemic, necessitated the development of novel care delivery models that could leverage the available nursing workforce in concert with emerging technology. One large national healthcare system successfully presented a case for the implementation of an innovative model that would team available nurses, a dedicated care partner and leverage technology to deliver adult acute care in inpatient units. The model was developed, prototyped and tested, with outcomes catalysing the system decision to scale and sustain the model across all acute care hospitals. A different type of implementation team with a focus on change methodology was organised, established upon the important values of the organisation, and utilised to implement the model on an initial 2,500 beds. Principles of Human Caring Science, relational coordination, professional governance and the sustainment of health information technology structures were both cornerstones of the model and enablers of the change process. This paper, in a case study format, details the model, change tactics and learnings from the implementation. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: change leadership; leadership execution; project management; novel care models; innovation; sustainment

The Veterans Health Administration (VHA), as exemplified by its mission statement, ‘Honor America’s Veterans by providing exceptional health care that improves their health and well-being’, has long recognised its moral obligation to provide the highest quality care for America’s heroes. In response to important healthcare industry trends — such as the shift to patient-centered models, integrated care and the rise of high reliability principles to reduce medical errors — the VHA has adapted its strategies to meet the evolving needs of Veterans. These trends have driven the VHA to commit to several important initiatives, including Whole Health, employee experience and patient experience programmes, while also adopting principles of high reliability organisations (HROs) to guide cultural transformation. Initially perceived as disparate efforts by managers and staff, the VHA shifted towards an organisational health framework to integrate these initiatives into a cohesive strategy. Organisational health serves as the unifying lens through which the VHA manages largescale transformations, ensuring that patient safety, holistic care and workforce well-being are consistently prioritised. This approach mirrors frameworks like the IHI Quadruple Aim and Quintuple Aim in broader healthcare, focusing on patient outcomes, employee engagement and care quality. The VHA’s success to date is demonstrated by important metrics, such as a 91.8 per cent trust level in VA healthcare, a 41 per cent improvement in the close-call-toadverse- event ratio since 2021, and the fact that 67 per cent of VA hospitals receive four or five-star Centers for Medicare & Medicaid Services (CMS) ratings. This paper explores how the VHA’s organisational health framework serves as a scalable model for aligning strategic efforts for optimum service delivery and employee satisfaction. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: organisational health; high reliability; transformation; Veterans Health Administration

The purpose of this quantitative study was to examine whether there is a relationship between patient care quality and safety and the financial status of acute care hospitals in the greater Chicago area. The methodology was to identify a random sample of 204 acute care hospitals. Patient care quality was operationalised as hospital readmission rates for pneumonia patients, heart failure patients and heart attack patients within 30 days of discharge. Patient care safety was operationalised as hospital-acquired infections. The results indicated that patient care quality and patient care safety were both positively associated with the hospital’s financial status. The conclusion was that the results underscore prevalent disparities in safety and quality of health care between hospitals with limited financial resources and those with sufficient financial resources. These disparities may spur healthcare management professionals to identify the best practices in the healthcare system to improve the quality and safety of health care in low financial status acute care hospitals. This article is also included in The Business & Management Collection which can be accessed at https://hstalks.com/business/
Keywords: Patient care quality; patient care safety; acute care hospital; financial status

Today’s healthcare organisations face serious challenges both within themselves and in the outside environment, from labour shortages, increased regulatory pressures and financial headwinds to the austerity from Centers for Medicare & Medicaid Services (CMS) and insurance companies as well as heightened competition in an increasingly monopolised market. While the issues are enormous, the solutions are within reach, and we have immensely capable and technically skilled leaders to do this work. What is becoming obviously missing, however, is not the technical and intellectual knowledge but the emotional and mindset skills for highly effective and transformative leadership. What is crucial to success is building strong and engaged organisational cultures as well as effectively negotiating with stakeholders, both of which require specific leadership behaviours and mindsets. This set of optimal behaviours are termed ‘upper brain behaviours’, which are geared towards collaboration and characterised by high emotional intelligence (EI), emotional maturity, collaborative mindset, commitment to inner and organisational purpose and mission and a strong ability to value people and interpersonal connections. While these behaviours are the ultimate pursuit of most people who seek self-improvement and growth, and this journey is never truly completed, we would like to describe the mindset transformations that we believe all leaders need to undertake in order to become highly effective in their work and consistently exhibit behaviours that lead to transformational leadership outcomes. This process is not only within reach and completely attainable but urgently needed in healthcare today.
Keywords: effective leadership; collaboration; abundance mindset; psychological safety; leadership growth

Healthcare organisations face continuous pressure to effectively manage expenses and improve profit margins while meeting the growing demands in the communities they serve. In parallel, the infrastructure is getting older, with deferred maintenance statistics showing that a significant number of US hospitals and the associated mechanical, electrical and plumbing assets required to safely operate those facilities have exceeded industry expected useful life and should be considered for replacement. The data further suggest that without intervention, this ageing trend will continue well into the next decade. Healthcare organisations must also consider hardening facilities against natural disasters and cyber-security threats, improving energy efficiency, reducing carbon emissions and reimagining the role of the facility itself in the future of healthcare. In some cases, these considerations are discretionary, while in others may be mandatory as part of legislative or regulatory requirements. Nevertheless, these requirements create a perfect storm of conflicting financial priorities that will challenge the entire industry for years to come. In the face of these ongoing challenges, traditional methods of budgeting and forecasting may no longer suffice. This paper will define the concept of asset-driven budgeting and introduce plant operating cost correlation coefficients and infrastructure renewal metrics to demonstrate a positive return on investment (ROI) in reducing deferred maintenance. Why? Looking past traditional US$/sq ft metrics, it is important to recognise that the primary cost drivers in any facility are the existing and installed assets themselves, the asset densities required for different service lines and occupancy types, and the age/ design/layout of the facility itself. Without transformational levels of investment to address deferred maintenance and alter the current state of the legacy infrastructure, it can be difficult to achieve anything other than incremental efficiency gains. With infrastructure investment, Risk of Inaction = ROI = Return on Investment.
Keywords: deferred maintenance; infrastructure investment; healthcare infrastructure; ageing infrastructure; sustainability; environment of care

Traditional change models, while valuable, often lack the structure and flexibility needed to address the complexities of today’s healthcare environment. The adoption of population health requires a coordinated, systematic approach with executive leadership sponsorship and a well-articulated change management strategy. The Ambulatory Quality Improvement Collaborative (AQIC) is a framework to drive populationlevel change to meet quality initiatives, including accountable care organisation (ACO) all-payer reporting models. The framework’s design includes an oversight committee of executive leaders utilising a unified change management strategy supported by an experienced project management team. The AQIC model emphasises a multidisciplinary, collaborative approach, bringing together stakeholders from across the healthcare system to drive system-wide quality improvement. The framework’s structure is detailed, outlining its important workstreams and their roles in driving change. Using case studies focused on hypertension control and depression screening, the effectiveness of the AQIC model in translating system-wide goals into tangible clinical improvements is demonstrated. This work highlights the critical role of data aggregation, performance management and health equity considerations in driving successful change initiatives. By leveraging data to identify disparities and track progress, the AQIC model enables targeted interventions and promotes equitable care delivery. The importance of continuous improvement and the AQIC model’s adaptability in addressing evolving healthcare challenges are emphasised.
Keywords: population health; change management; quality improvement; health equity; data aggregation; system transformation; depression screening; hypertension management

Children’s Mercy Hospital (CMH), a 390-bed free-standing paediatric hospital in Kansas City, Missouri, implemented a formalised patient progression programme in 2022 to enhance patient throughput from pre-arrival to discharge. Utilising Lean process improvement methodologies, CMH identified 88 projects aimed at improving patient progression. In May 2023, CMH opened a patient progression hub, centralising key teams and integrating advanced technology to monitor and manage patient flow. A significant emphasis was placed on discharge and care coordination, with the mission of ensuring safe and timely discharges. Important initiatives included hiring a discharge expediter (DE) to address discharge barriers and implementing projected discharge date (PDD) and clinical readiness date (CRD) to improve discharge transparency and preparation. The patient progression hub features technology from GE Healthcare, with 16 screens continuously displaying pertinent throughput information such as organisational capacity, emergency department (ED) capacity, planned and confirmed discharges, and patients needing transfer from the intensive care unit (ICU) to the medical/surgical units. This real-time data sharing has been crucial in coordinating care and expediting discharges to address system bottlenecks. Additionally, CMH introduced ‘lightning rounds’, which are quick multidisciplinary huddles to review discharge needs. Afternoon rounds were implemented to facilitate continuous communication between charge nurses and care managers. These efforts, supported by innovative technology, have led to substantial improvements in patient outcomes. Timely, well-coordinated discharges have reduced hospital stay durations, minimised readmission rates and enhanced overall patient satisfaction. The initiatives have also resulted in improved capacity management, allowing CMH to better serve its patient population and ensure high-quality, patient-centred care.
Keywords: paediatric hospital; patient progression; Lean process improvement; patient throughput; discharge coordination; patient progression hub

The rising incidence of chronic disease poses a challenge to healthcare leaders striving to improve the health of the populations they serve. Although programmes and solutions are often available to assist patients in managing and even reversing their chronic diseases, practical constraints frequently hinder participation and success. Cardiac rehabilitation for the 7.8 per cent of US adults with coronary artery disease is no exception. Traditional programmes have limited space and high out-of-pocket costs and require frequent in-person visits, resulting in low enrolment and completion rates. This article highlights Kaiser Permanente’s (KP) journey in piloting and scaling a virtual cardiac rehabilitation (VCR) programme that uses wearable technology and a case management model to overcome barriers to participation and success in cardiac rehabilitation. To date, the programme has enrolled more than 28,000 patients and achieved enrolment rates 3 times higher and graduation rates 50 per cent higher than traditional cardiac rehabilitation programmes. Readers of this article will gain insights into the operational and technological aspects of the VCR programme, the lessons learned as it was developed and scaled, and opportunities for enhancing VCR to further elevate the patient and clinician experience.
Keywords: value-based care; chronic disease management; innovation; telehealth; technology

A predominant reason employees leave their academic healthcare organisation is career advancement. This reason has been on the rise with the market favouring candidates, given a shrinking supply of qualified healthcare workers. This study showcases intentional interventions to support advancement of employees into leadership roles. The University of Texas MD Anderson Cancer Center (MDA) tackled career advancement through a committee with two priority areas. First, it focused on providing learning, sponsorship and mentoring opportunities, offering initiatives such as an annual sponsorship workshop, an education series and formal sponsorship/mentorship requirements. Secondly, the committee aimed to increase visibility and serve as a national model for advancing healthcare leaders, employing metrics like engagement survey scores and tracking internal movement into leadership roles. The institution’s efforts and initiatives have yielded positive outcomes, evidenced by increased engagement survey scores and by an increased rate of internal hires into leadership roles. Participant feedback from the sponsorship workshop underscores its effectiveness in career development and leadership preparation. The committee emphasises sustained efforts to build on its success, with ongoing commitment to visibility metrics and leadership development. The demonstrated success of MDA’s approach positions it as a replicable model for other academic healthcare organisations seeking to retain talent in leadership.
Keywords: career development; workplace interventions; organisational metrics; healthcare management

To enhance the high reliability organisation (HRO) journey and staff psychological safety at the Edward Hines Jr. VA Hospital, the Executive Leadership Team (ELT) created a culture where staff were provided a venue to speak up, and with confidence, without fear of reprisal when challenging leadership and sharing ideas. The results from the most recent All Employee Survey (AES) demonstrated increased employee engagement. The collective commitment led to a significant achievement of a threepoint increase in the best places to work rating. The AES survey also indicated a positive shift in psychological safety, risk identification and just culture, error transparency and risk mitigation, teamwork cohesion and overall staff engagement. Employees identified increased trust in leadership due to increased transparency and communication. An increased sense of diverse viewpoints in decision-making processes and a collective fostering of an environment of diversity, equity and inclusion is evident as fewer Hines team members report feeling discriminated against. Radical transparency has spearheaded efforts in leading culture change, which, in turn, has increased staff psychological safety, retention and patient safety. Leadership at Hines VA has made having the hard conversations comfortable and acceptable ‘the way we work’.
Keywords: radical transparency; high reliability organisation; safety; psychological safety; teamwork; just culture

In the ever-changing landscape of healthcare management, the role of physician leaders has become increasingly important. Physicians with strong leadership and management skills are well positioned to bring medical expertise to the business side of healthcare, benefiting their organisations immensely. Effective physician leaders also foster a healthier team environment, making a positive impact on their care team and patients. Traditional medical education, while strong in clinical training, typically falls short in adequately preparing physicians for leadership roles. This prompted the University of Pittsburgh Medical Center (UPMC) to launch an internal initiative to support physician leadership development. This case study looks at the journey from concept to successful implementation of UPMC’s inaugural leadership development programme for physicians. It also addresses the challenges of deploying the programme during a global pandemic and the lessons learned from the experience. Through internal surveys, UPMC recognised that physicians wanted professional growth and development opportunities. In 2017, UPMC formed an internal board of physician leaders to identify the specific learning needs of that population. In 2018, UPMC hired individuals dedicated to the creation of a leadership programme for physicians, now branded Physician Leadership Essentials (PLE). Before the programme’s launch, physicians were left to seek development outside the organisation. Following a pilot in 2019, the programme was deployed on a larger scale, starting in January 2020. As of 29 February 2024, 482 participants from various speciality and practice locations participated in 26 rolling cohorts of PLE. Twenty cohorts have completed the programme, resulting in 314 alumni. Today, there are six ongoing cohorts with 139 active participants. The programme exhibits 99.5 per cent favourability and a 92 per cent retention rate. Participants have completed 247 leadership challenge projects. This programme has fostered a culture of growth and development for physicians across UPMC and enhanced cross-functional and cross-departmental collaboration. It has also unlocked some of the untapped leadership talent of physician leaders, increasing not only their effectiveness but also their sense of professional fulfilment and engagement.
Keywords: leadership development; physicians; case study; healthcare management; advisory board; global pandemic; engagement; lessons learned

Rural hospitals are facing unprecedented financial challenges in the United States. The many factors contributing to the economic headwinds for rural hospitals result in reduced clinical services offered in local communities. Affiliations, mergers and acquisitions are a path for rural facilities to keep their doors open. Maintaining independence as a rural hospital by employing an affiliation approach with a larger health system can be a sustainable path under the right circumstances. This paper outlines a successful 12-year affiliation between a critical access hospital (CAH) and an academic medical centre (AMC) in Oregon. This paper outlines the underlying structure and governance of the collaboration, important management approaches, lessons learned and the results over the life of the affiliation. The results for the CAH include the growth of annual ambulatory visits from 15,000 to 131,000, adding 430 new employees, and increasing the total annual operating revenue from US$51m to US$193m. The results for the AMC include the development of an innovative joint venture rural cancer centre, the growth of rural graduate medical education rotations, and expanding clinical department faculty who work in a rural community setting. Enhancing health care in underserved areas aligns with the AMC’s statewide mission to serve all Oregonians as the AMC. There have been significant benefits to patients by increasing access to speciality services locally, including reducing miles travelled for cancer care. Our case study demonstrates that an affiliation structure between a CAH and an AMC can be a sustainable and beneficial approach to improving access to quality health care in rural communities and can strengthen the financial performance of both organisations.
Keywords: affiliations; finance; governance; physician workforce; rural healthcare

The healthcare landscape is increasingly complex, characterised by economic uncertainty, regulatory challenges and rising operational costs. This paper provides a strategic framework for healthcare leaders to navigate this challenging deal environment. Despite economic pressures, merger and acquisition (M&A) activities remain robust, driven by strategic considerations rather than pure expansion motives. Important trends include horizontal and vertical consolidation, innovative joint ventures, strategic partnerships and direct equity investments, all aimed at enhancing operational efficiency, expanding into emerging value pools, and fostering innovation. This paper also delves into the evolving transaction strategies within healthcare systems, highlighting the importance of programmatic capital allocation and structured innovation investments. It outlines the crucial factors for successful execution, such as modernising capital allocation; creating effective governance structures; and building capabilities to test, learn and scale innovations. By leveraging these strategies, healthcare systems can better position themselves for sustainable growth, improve patient outcomes and create value in an increasingly dynamic and competitive market.
Keywords: innovation; M&A; partnerships; strategy; transactions; trends; value-based care

Investment in physical space is a key strategic decision for healthcare managers. Understanding the current utilisation of clinical space is a significant input for this decision. Historically, direct observation or analysis of electronic health record (EHR) timestamps has been used to assess ambulatory space utilisation. Manual observation is prohibitively expensive, prospective and infeasible for large spaces. EHR data is limited to electronically captured workflows and to the quality of data capture. Two pilots explored the efficacy of real-time location systems (RTLS) to assess outpatient space utilisation to assist healthcare management professionals to make space allocation decisions. RTLS was shown to be viable, with accuracy that was not different from EHR-derived utilisation. RTLS had the following benefits: (a) more granular information, (b) data coverage in areas without EHR timestamps and (c) real-time assessment of utilisation. RTLS is an option for ambulatory care managers to understand the needed space for clinical operations.
Keywords: facilities; real-time location systems; space utilisation

With growing recognition that climate change is a significant threat to human health, healthcare leaders are increasingly recognised as critical allies in addressing this threat. This paper describes the approach that the International Hospital Federation’s Geneva Sustainability Centre is pursuing to better prepare healthcare leaders for this reality and the evidence-based principles informing the team’s work. We also share lessons learned so far, as well as recommendations for health system leaders pursuing work within their own organisations and communities.
Keywords: computer-based simulations; environmental sustainability; leadership development

Critical thinking skills of registered nurses are important to improve patient safety through recognition of an adverse change in a patient’s condition and initiation of appropriate action. The purpose of this study was to determine whether participation in case scenario simulation exercises significantly increased the critical thinking skills of registered nurses. The study used a simulation program developed by the American Association of Critical Care Nurses. Sixty registered nurses in an acute care hospital participated in the study. Although the results failed to indicate a significant statistical difference in the critical thinking skills of the registered nurses following completion of the assigned modules, limitations of the study may have adversely affected findings. Additional research is warranted to further explore the potential of using case-based simulation exercises to promote critical thinking skills in registered nurses. Wider implications include promoting an environment of continual learning to strengthen the critical thinking skills of staff. Implementation of case scenario simulation exercises may be an effective way to develop critical thinking skills and reduce incidences of registered nurses failing to rescue a patient when intervention is required. The actionable findings of this research may generate further studies to enhance the practice of nursing, improve patient safety and reduce the number of adverse events involving hospitalised patients.
Keywords: adverse events; case scenarios; critical thinking skills; sentinel events; simulation; education and training of registered nurses; quality of care

The aim of this paper is to present a systems approach to support leaders in creating a satisfying and meaningful career experience for colleagues which promotes optimal subjective well-being and healthspan. The intention is to help people do better. Kindness is helping people do better. There is an occupational health challenge in healthcare, with high rates of professional burnout, moral distress, turnover and work–life disintegration. An evidence synthesis of a narrative literature review identified subjective well-being and healthspan determinants primarily in the sphere of control of organisations. They are categorised into four domains: agency (control over work–life), collective effervescence (meaning, energy and harmony in groups of people with shared purpose), camaraderie (social connectedness) and positivity (optimism and caring). Ten systems that can improve staff subjective well-being and healthspan are presented.
Keywords: allostatic load; leadership; management; occupational health; organisational democracy; participative management

How we educate nurses in modern America is at a crucial juncture as healthcare evolves, demographics shift and technological advancements reshape the landscape. In this paper, we advocate for a fundamental shift in how nurse candidates are enrolled and trained, emphasising collaboration among educators, employers and policymakers. Addressing systemic challenges in nurse education, we examine the impact of ageing demographics, increasing diversity and the rise of nontraditional learners. Proposing alternative pathways for enrolment and leveraging technology for personalised learning experiences, we argue for inclusivity, diversity and adaptability in nurse education. Through effective collaboration between stakeholders, we envision a future where nurse education meets the demands of a changing healthcare industry. Our goal is to inspire transformative action, foster innovation and promote equitable access to quality education for all who want to become a nurse. This paper aims to spark discussions and guide stakeholders towards developing a resilient, adaptable and community-connected nursing workforce.
Keywords: enrolment; healthcare system; nurse education; partnerships; technology; training

Health systems and medical groups are currently facing unprecedented challenges, including the highest inflation rates in four decades. These challenges are compounded by post-pandemic issues, such as the Great Resignation, staffing shortages, financial constraints and increased competition in new markets. Moreover, there is a pressing need to work towards achieving the Triple Aim of healthcare: improving the individual experience of care, enhancing population health and reducing per capita costs. Against this backdrop, this paper aims to explore successful strategies implemented by health systems and medical groups across the USA. It will highlight numerous initiatives focused on either enhancing revenue or reducing costs, all aimed at achieving long-term, sustainable outcomes. By drawing upon the experiences of high-performing healthcare organisations and medical groups, readers can gain insights into reimagining patient care delivery through effective dyad partnerships, innovative team-based care models and the cultivation of a positive organisational culture.
Keywords: Cost; medical groups; performance improvement; revenue; teamwork

Healthcare organisations have been facing increasing complexity since the pandemic, demanding improved outcomes with fewer resources. Collaboration and alignment are crucial amidst evolving market dynamics and changing patient expectations. Innovative leadership models like the triad/dyad approach offer a solution, fostering interprofessional teamwork to enhance patient care and drive cultural transformation. The model promotes collaboration, innovation and continuous improvement, fostering a culture of shared accountability. Results demonstrate improvements in quality, culture and operational metrics, showcasing the model’s effectiveness in driving transformative change. While challenges exist, embracing triad/dyad leadership offers significant benefits for healthcare organisations. Prioritising collaboration and investing in leadership development are essential for sustained success and cultural transformation.
Keywords: change leadership; performance excellence; talent development; teamwork; triad/dyad model; triad leadership

This paper describes a large statewide initiative in Arizona led by the Arizona Medicaid programme to integrate the delivery of primary care and behavioural services. Healthcare in the USA remains fragmented, as reflected in no small measure by the separation of primary care and mental health services, in both structure and delivery. The fact that this historical separation continues to be perpetuated is detrimental to the goals of the Triple Aim. The fragmentation between both clinical service lines is further compounded by the high rate of co-occurring physical and mental illness, shortage of mental health professionals, under-skilling of primary care providers in the management of mental health, and stigma associated with mental illness. Underserved communities, where trust deficits of healthcare systems are commonplace, are especially vulnerable to the untoward effects of fragmented services. In this paper a framework is described to integrate primary care and behavioural health, implemented as a multi-year, multi-stakeholder programme at microsystem level, with policy implications for improving access, outcomes, costs and disparities.
Keywords: Multisector alignment; primary care and behavioural health integration; value-based contracting

In the ever-evolving healthcare landscape, hospitals routinely grapple with daily disruptions and unforeseen events affecting resources and capacity. This paper explores the implementation and impact of the Rochester Hospital Operations Command Center (RHOCC) as a strategic response to challenges faced by the Mayo Clinic Hospital campuses in Rochester. The RHOCC, developed with an expedited timeline in response to capacity issues, exacerbated by COVID-19, serves as a centralised hub for real-time monitoring, coordination and decision-making related to patient flow. The process of establishing the command centre involved role identification, skill set determination, location of important personnel in an organised central space and vendor selection to develop the necessary infrastructure. Dashboards were developed to provide real-time actionable insights into external transfers, surgical and other planned admissions, emergency department status, patient throughput and discharges. These dashboards include colour-coded keys highlighting thresholds related to patient flow metrics and are used to facilitate daily huddles and enhance transparency and data-driven decision-making among hospital stakeholders. The outcomes of implementing the RHOCC include improved efficiency and collaboration, as well as a significantly enhanced ability to proactively respond to factors affecting census. The development of a command centre — driven by leadership endorsement and a commitment to continuous improvement — emerges as a transformative strategy in healthcare innovation. The RHOCC’s approach of building capability, fostering inclusion and articulating a vision of providing superior care while driving impactful improvements, positions it as a leading force in creating operational efficiencies to define healthcare delivery.
Keywords: command centre; hospital management; hospital coordination; census management; hospital census; patient flow

Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.
Keywords: diffusion of innovation; nurse retention; patient safety; team-based models; virtual nursing; workflow

Accurate clinical documentation is vital for any healthcare facility. Documentation in the record plays a critical role in reimbursement, case mix index, risk adjusted quality outcomes, length of stay days, etc. The need for Clinical documentation improvement (CDI) specialists is high. In this article, we discuss the success we have had by transitioning from a traditional approach to capture severity reporting (CDI 1.0), which relies heavily on the concurrent review of medical records by the CDI team, to a patient population driven and provider focused approach (CDI 2.0).
Keywords: case mix index; CMI; severity reporting; CDI; clinical documentation; coding; inpatient; education; reimbursement; inpatient